Newport News surgeons now doing outpatient back surgery

Spine specialist Dr. Jeffrey Carlson has pioneered a new outpatient lumbar fusion surgery that, in some cases, allows patients to return home the same day.

Spine specialist Dr. Jeffrey Carlson has pioneered a new outpatient lumbar fusion surgery that, in some cases, allows patients to return home the same day.

Prue Salasky, psalasky@dailypress.com | 757-247-4784Daily Press

Wracked by years of pain, struggling to maintain work and unable to lift his infant daughter, Chad Morgan was despondent. Then, on his way to yet another doctor's appointment, the 35-year-old air-flow technician, a Virginia Beach resident, heard a radio ad that changed his life.

The ad for Orthopaedic & Spine Center specialists in Newport News announced the group's specialty in spine care. "The back — of all things — you want someone who specializes in just that one thing, not shoulders or ankles," said Morgan, who had acute pain from disc degeneration in his lower back. It led him the very next day to Harvard-trained spine surgeon Jeffrey Carlson, who had just started using SpineFrontier instruments to perform lumbar fusions on an outpatient basis at Mary Immaculate Hospital.

"Patients are more and more concerned about getting back to work and doing what they need to do at home," said Carlson, who believes he's the first in Virginia to conduct the surgery on an outpatient basis. At one time, a week in the hospital post-surgery was standard; now insurance typically covers a 2-to-3- day stay. "People would rather be at home recovering than at the hospital," he said, dismissing the insurance issue as an impetus for out-patient surgery. "I was glad to be back in my own bed," agreed Morgan.

There is no difference in charge for the procedure, and it allows healthy patients with no co-morbidities to decide if they want to stay or go home. Smaller implements now allow for smaller incisions — reduced from 6 inches to 2 to 3 inches — that cause much less injury to the muscles and tendons, which in turn speeds recovery, Carlson added. Similarly quick-turnarounds have become standard for hip and knee replacement surgeries at Mary Immaculate Hospital, where surgeons perform hundreds each year.

Carlson started by doing cervical (neck) fusions and sending patients home after a couple of hours. In April, he did his first outpatient spinal lumbar (lower back) fusion, taking the disc out to provide stability and relieve pain by taking pressure off the nerves. He likened the use of screws and rods to an "internal cast." People have always thought about fusion surgery as long drawn-out with a one-year recovery, he said. After this one-hour procedure, patients routinely return to work after between 10 days and a month, he said. To date, Carlson has done about a dozen, still a small fraction of the 50 spinal fusions he performs each month.

Until August, he and Mark McFarland, another OSC surgeon, only did single-level fusions, but they are starting to contemplate two- and three-level fusions. "We're trying to expand the number of levels and the type of surgeries we can do," said Carlson, who recently had a two-level cervical fusion patient return home the day of surgery. "Right now, it's very patient-specific. We're slowly working to improve techniques," said McFarland. The goal is that the procedures will become easily reproducible by other surgeons. He anticipates that eventually between 50 and 70 percent of their patients, including those requiring more complex lumbar fusions, will be able to have surgery on an outpatient basis. "Most of it has to do with the physicians' perspective," said Carlson. "We need to listen to the patients. They'd much rather be at home."

Morgan had heard the horror stories. He knew people still in pain years after fusion surgery, people with compromised range of motion, lack of flexibility, and those restricted in their activities. "It took me less time to recover and get back on my feet after the surgery than to have all the physical therapy to satisfy the insurance," he said. He walked out of the recovery room and returned to work four weeks post-surgery.

Prior to the minimally invasive surgery, it took him around two months to satisfy the demand by his insurance company that he have a minimum of 10 consecutive physical therapy sessions. When the first couple of sessions increased his pain and worsened his condition, Morgan's therapist wrote a letter to that effect; the appeal was denied. After returning to therapy, as required, Morgan became virtually bed-ridden and had to stop work and go on short-term disability. The appeal was denied twice before the insurance company agreed to pay for the surgery.

Carlson frets about the insurance issue. "Why does it have to take such a long time to get through the system? We're making people better faster. Workmen's comp understands that. His office took care of all the details. "We felt really comfortable right away at the first visit," said Morgan's wife, Katie. "We never felt anyone was more on our side. He really knows what he's doing."

On July 8, Katie drove Morgan to Mary Immaculate Hospital in Newport News for the lumbar spinal fusion. He returned home to Virginia Beach that evening. Two days later he answered the door to the visiting nurse and at four weeks post-surgery he was back at work, where he spends most of his day on his feet and going up and down ladders. "I have no pain. I don't limp. And I can pick up my baby daughter. People don't understand how heart-wrenching it is when you have a baby daughter and you can't hold her or even feed her a bottle. It's heartbreaking. Now I can take care of her," he said, cradling 9-month-old Claire in his arms.

Morgan is now able to participate fully in family life, including packing to move into their new home. He plays with his son, Colton, 13, and takes their dog, Miller, for daily 3-mile walks. Before the surgery, Katie had to do all the domestic chores in addition to working full time.

Morgan had suffered low-back pain from degenerative disc problems for six years before a crisis in April sent him to the emergency room — and then again, by ambulance, a few weeks later. Steroids and pain medicine kept him going, though he was increasingly disabled.

Cheryl Bowen of Hampton had a similar story. The 58-year-old couldn't move for more than four hours a day because of "excruciating pain" at the base of her spine. She tried steroid shots and physical therapy. Nothing worked.

Finally, she had the surgery. "I was fine with outpatient. That's all I needed," she said, noting that her insurance paid for eight follow-up home-care visits. She wore a brace for six weeks, after which she resumed normal activities pain-free. "I'm pleased," she said.

What is SpineFrontier?

The company, founded in 2008, develops devices and instruments for spinal fusion and less exposure surgery (LES). Dr. Jeffrey Carlson works with the company to develop instrumentation. During an August single-level lumbar spinal fusion surgery he used four pedicle screws (sizes range from 4 to 10 mm), two rods and locking caps to stabilize the patient's spine. A company rep, Amanda Dalton, set up the instruments and attended the surgery at Mary Immaculate Hospital, which she said is the only hospital in the region using the specialized instruments and techniques. Others who use it are in N. Virginia, Washington D.C. and Maryland. For information, go to http://www.spinefrontier.com.